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Choi J, Kaghazchi A, Sun B, Woodward A, Forrester JD. Systematic Review and Meta-Analysis of Hardware Failure in Surgical Stabilization of Rib Fractures: Who, What, When, Where, and Why? J Surg Res 2021; 268:190-198. [PMID: 34333416 DOI: 10.1016/j.jss.2021.06.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/10/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical stabilization of rib fractures (SSRF) is increasingly used to reduce pulmonary complications and death among patients with rib fractures. However, the five Ws of hardware failure -who, what, when, where, and why- remains unclear. We aimed to synthesize available evidence on the five Ws and outline future research agenda for mitigating hardware failure. METHODS Experimental and observational studies published between 2009 and 2020 evaluating adults undergoing SSRF for traumatic rib fractures underwent evidence synthesis. We performed random effects meta-analysis of cohort/consecutive case studies. We calculated pooled prevalence of SSRF hardware failures using Freeman-Tukey double arcsine transformation and assessed study heterogeneity using DerSimonian-Laird estimation. We performed meta-regression with rib fracture acuity (acute or chronic) and hardware type (metal plate or not metal plate) as moderators. RESULTS Twenty-nine studies underwent qualitative synthesis and 24 studies (2404 SSRF patients) underwent quantitative synthesis. Pooled prevalence of hardware failure was 4(3-7)%. Meta-regression showed fracture acuity was a significant moderator (P = 0.002) of hardware failure but hardware type was not (P = 0.23). Approximately 60% of patients underwent hardware removal after hardware failure. Mechanical failures were the most common type of hardware failure, followed by hardware infections, pain/discomfort, and non-union. Timing of hardware failure after surgery was highly variable, but 87% of failures occurred after initial hospitalization. Mechanical failures was attributed to technical shortcomings (i.e. short plate length) or excessive force on the thoracic cavity. CONCLUSIONS SSRF hardware failure is an uncommon complication. Not all hardware failures are consequential, but insufficient individual patient data precluded characterizing where and why hardware failures occur. Minimizing SSRF hardware failure requires concerted research agenda to expand on the paucity of existing evidence.
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Affiliation(s)
- Jeff Choi
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, California; Department of Epidemiology and Population Health, Stanford University, Stanford, California; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, California.
| | - Aydin Kaghazchi
- Department of Epidemiology and Population Health, Stanford University, Stanford, California; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, California
| | - Beatrice Sun
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, California; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, California
| | - Amanda Woodward
- School of Medicine, Stanford University, Stanford, California
| | - Joseph D Forrester
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, California; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, California
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The Effects of Add-On Self-Care Therapy on Epidural Catheter Analgesia and Pain in Patients after Surgical Stabilization of Multiple Rib Fractures. Pain Manag Nurs 2021; 22:764-768. [PMID: 33674241 DOI: 10.1016/j.pmn.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/29/2020] [Accepted: 01/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Epidural (EPI) catheter analgesia is frequently prescribed as a regional analgesic technique to patients with multiple rib fractures (MRF) following surgical stabilization of rib fractures (SSRF). AIMS We aimed to study the effect of add-on self-care therapy on recovery and quality of life (QoL) in patients on EPI analgesia after surgical stabilization of rib fractures (SSRF). DESIGN/SETTINGS/PARTICIPANTS/SUBJECTS A total of 267 eligible patients with MRF who received EPI catheter analgesia after SSRF were recruited, and assigned to one of two groups in a random fashion: intervention group received education on self-care therapy, while the control group did not. METHODS Pain scores, incentive spirometry (IS) volumes, oxygen saturation (SpO2), respiratory rate, hospital length of stay (LoS) and QoL were evaluated. RESULTS Compared with control group, the intervention group showed significantly improved pain scores, IS volume, respiratory rate, and SpO2. Hospital LoS was shorter for the intervention group than the control group. Overall QoL scores in the intervention group were also significantly better than control patients. CONCLUSIONS Education on self-care therapy significantly benefited pain management, recovery, and QoL for patients with MRF who received EPI catheter analgesia after SSRF operation.
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Hussain A, Hunt I. Acute Diaphragmatic Injuries Associated with Traumatic Rib Fractures: Experiences of a Major Trauma Centre and the Importance of Intra-Pleural Assessment. J Chest Surg 2021; 54:59-64. [PMID: 33767010 PMCID: PMC7946519 DOI: 10.5090/kjtcs.20.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%) . A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5–10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiothoracic Surgery, St. George's Hospital, London, UK
| | - Ian Hunt
- Department of Cardiothoracic Surgery, St. George's Hospital, London, UK
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Zhang L, Liu W, You H, Chen Z, Xu L, He H. Assessing the analgesic efficacy of oral epigallocatechin-3-gallate on epidural catheter analgesia in patients after surgical stabilisation of multiple rib fractures: a prospective double-blind, placebo-controlled clinical trial. PHARMACEUTICAL BIOLOGY 2020; 58:741-744. [PMID: 32749173 PMCID: PMC7470119 DOI: 10.1080/13880209.2020.1797123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/25/2020] [Accepted: 06/15/2020] [Indexed: 05/24/2023]
Abstract
CONTEXT Thoracic trauma results in multiple rib fractures (MRF), and surgical stabilisation of rib fractures (SSRF) can relieve fracture pain. Epigallocatechin-3-gallate (EGCG) is reported to exhibit beneficial effects in bone-related metabolic and differentiation processes. OBJECTIVE To study the clinical effect of EGCG on regional analgesia for pain relief in MRF patients after SSRF. MATERIALS AND METHODS Ninety-seven MRF patients (61 males, 36 females) who were on epidural catheter analgesia after SSRF were recruited. They were randomly divided into: oral EGCG 100 mg (oral grade) twice daily for 10 days and placebo groups. Pain scores, incentive spirometry (IS) volumes, respiratory rate and oxygen saturation (SpO2) were assessed day 10 after SSRF. RESULTS Comparing results from the placebo and EGCG group, in the 10-day intervention course, oral EGCG reduced pain score (8 at base line vs. 4 at end of intervention in EGCG group, p < 0.05; 4 in EGCG group vs. 6 in placebo group at end of intervention, p < 0.05), improved IS volume (713 at base line vs. 1072 at end of intervention in EGCG group, p < 0.05; 1072 in EGCG group vs. 953 in placebo group at end of intervention, p < 0.05) and respiratory rate (24 at base line vs. 15 at end of intervention in EGCG group, p < 0.05; 15 in EGCG group vs. 19 in placebo group at end of intervention, p < 0.05). However, no further enhancing effect on SpO2 was observed in the EGCG group (0.98 in EGCG group vs. 0.98 in placebo group at end of intervention, p > 0.05). DISCUSSION AND CONCLUSIONS Although the study is limited by a relatively small sample size and lack of serum factor analysis, the key results and the study design, for the first time, nevertheless pave the way for trials with larger number of patients to understand the effect of EGCG in MRF patients that are undergoing SSRF.
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Affiliation(s)
- Lihong Zhang
- Department of Anesthesiology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Weifeng Liu
- Department of Anesthesiology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Haiping You
- Department of Anesthesiology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Zhiyuan Chen
- Department of Anesthesiology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Liming Xu
- Department of Anesthesiology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Hefan He
- Department of Anesthesiology, Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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Xia H, Zhu D, Li J, Sun Z, Deng L, Zhu P, Zhang Y, Li X, Wang D. Current status and research progress of minimally invasive surgery for flail chest. Exp Ther Med 2019; 19:421-427. [PMID: 31885692 PMCID: PMC6913304 DOI: 10.3892/etm.2019.8264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/25/2019] [Indexed: 01/27/2023] Open
Abstract
Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20–25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost-effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video-assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.
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Affiliation(s)
- Honggang Xia
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China.,School of Medical Engineering and Translational Medicine, Tianjin 300000, P.R. China
| | - Deqing Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Jing Li
- Teaching and Research Division, Tianjin Medical College, Tianjin 300000, P.R. China
| | - Zhongyi Sun
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Limin Deng
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Pengzhi Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Yongmin Zhang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Xuan Li
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Dongbin Wang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
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Zhang Q, Song L, Ning S, Xie H, Li N, Wang Y. Recent advances in rib fracture fixation. J Thorac Dis 2019; 11:S1070-S1077. [PMID: 31205764 DOI: 10.21037/jtd.2019.04.99] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As a means of treating rib fractures, surgical stabilization of rib fractures (SSRF) has been carried out sporadically for nearly 100 years. However, with the recent advent of new materials and technologies suitable for SSRF, the developmental rate and data concerning SSRF have increased greatly. The main manifestations of these advancements include the improvement of the preoperative localization method by combining CT scanning with three-dimensional reconstruction technology and ultrasound application to accurately locate fractures. The bone fracture plate is specifically used for rib fixation, and the intramedullary fixation devices and special SSRF tools make SSRF relatively simple. The application of 3D printing technology can accurately reproduce the anatomical shape of the fracture site under in vitro conditions before operation and combine with the internal fixation of chest wall, especially the thoracoscopy-assisted internal fixation of the chest wall, to achieve the minimally invasive internal fixation of the rib fracture. Absorbable internal fixation materials and thoracoscopic SSRF are considered the primary future research directions.
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Affiliation(s)
- Qiang Zhang
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing 100009, China
| | - Lei Song
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing 100009, China
| | - Shaonan Ning
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing 100009, China
| | - Hao Xie
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing 100009, China
| | - Nan Li
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing 100009, China
| | - Yanbin Wang
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing 100009, China
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Liu Y, Xu S, Yu Q, Tao Y, Peng L, Qi S, Han H, Chen M. Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:439. [PMID: 30596069 DOI: 10.21037/atm.2018.10.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background In this study, we aimed to evaluate the clinical effects of multiple rib fracture treatments using a rib plate fixator. Methods From June 2014 to December 2016, 110 cases of patients with multiple rib fractures were collected for our study from the 105th Hospital of PLA; 59 patients were treated by surgery, and 51 patients received conservative treatment. We compared surgical rib plate fixation with conservative treatment for patients with multiple rib fractures. Results The hospital stay for the surgical group was 13.12±4.21 days, whereas for the conservative group, it was 18.57±5.39 days (P<0.001). The duration of the thoracic intensive care unit (ICU) stay was 4.02±1.41 days in the surgical group and 5.06±1.80 days in the conservative group (P=0.001). The indwelling thoracic drainage tube time was 5.85±1.52 days in the surgical group and 8.26±1.96 days in the conservative group (P<0.001). The index of partial pressure of arterial oxygen (PaO2) was 91.05±10.88 mmHg 24 h after surgery whereas 86.49±11.69 mmHg 24 h after conservative treatment (P=0.036). The index of partial pressure of carbon dioxide (PaCO2) was 37.80±2.86 mmHg 24 h after surgery and it was 39.08±2.46 mmHg 24 h after conservative treatment. The hospitalization cost was 6,206.44±371.42 USD for the surgical group and 4,544.61±524.79 USD for the conservative group (P<0.001). The number of rib displacement cases after treatment was 1 case in the surgical group and 2 cases in the conservative group (P=0.475). Atelectasis occurred in 10 cases in the surgical group and in 17 cases in the conservative group (P=0.046). Delayed hemopneumothorax occurred in 7 cases in the surgical group and in 16 cases in the conservative group (P=0.012). Conclusions Surgical treatment is a safe and effective therapy for multiple rib fractures. Our data suggested that surgical treatment can significantly shorten the patients' pain-endurance time, hospitalization time, and can reduce complication incidence. Severe rib fracture patients might benefit from surgical fixation.
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Affiliation(s)
- Yongjing Liu
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Shun Xu
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Qi Yu
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Yu Tao
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Leilei Peng
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Shengbo Qi
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Hao Han
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
| | - Mengran Chen
- Department of Cardiothoracic Surgery, The 105th Hospital of Chinese People's Liberation Army, Hefei 230031, China
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Leenen LPH. Focus on chest trauma. Eur J Trauma Emerg Surg 2017; 43:153-154. [PMID: 28258283 DOI: 10.1007/s00068-017-0780-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/21/2017] [Indexed: 11/25/2022]
Affiliation(s)
- L P H Leenen
- Department of Trauma, University Medical Centre Utrecht, Suite G04.228, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands.
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